Just because Gordon Campbell is credited with an idea doesn't mean it is bad, although one is hard pressed to find many good examples, and many will remember that what Campbell has done bears little or no resemblance to what he campaigned on. Nevertheless, it would be very good if the federal government took responsibility for delivering a national Phamacare program based on the BC model, and better yet if that model was the version before the Campbell cuts. Roy Romanow has been quoted as saying the chances of that are "slim and none". He shouldn't be in such a rush to shield the federal government.

The history of the development of Medicare in Canada has seen the federal government using its superior taxing power to offer funding to the provinces, which have constitutional jurisdiction in health care. The provinces have gotten the short end of the stick since they take all the risks of managing ever expanding programs while the federal government gradually withdrew its funding. In the case of national Pharmacare, the provinces have pointed to the fact that Ottawa has control over the Patent Act and control over what drugs are approved for dispensing. Since it controls powerful policy tools that can be used for cost containment, wouldn't it be better for it to take full responsibility for a program rather than offering a little money and then watching the provinces struggle to control costs?

British Columbians know that Premier Campbell cannot be taken at his word. He received credit for the proposal that originated with the Canadian Federation of Nurses, so those who are used to seeing broken promises and the use of tricky words are looking for the substance behind the premiers' plan. Rather than raising coverage across the country to the level offered in BC, the plan might be for "catastrophic coverage" and nothing more. In other words, the plan might encourage Ottawa to cover expenses in excess of $10,000 while provinces cancel their coverage for anything less than that. That would be a major step backward. Campbell has a lot of explaining to do to satisfy skeptics that his proposal is a sincere effort to expand Medicare rather than a cheap political trick to dump on Ottawa while further cutting provincial spending.

People who need prescriptions have a real problem. It is not good enough to watch the blaming game as the provinces and Ottawa point fingers at each other. Drug costs are the fastest rising component of health care. Total expenditures on prescription drugs now exceed the amount that is paid to physicians, and are second only to hospital costs. The provinces have responded by shifting drug costs onto the people who need prescriptions. Even after shifting costs, BC predicts that its Pharmacare program will expand at double digit growth rates. In the long term, no program can consistently outpace the growth in government revenue; that is not sustainable.

Many physicians and health economists are quick to point out that people, particularly seniors, are admitted to hospital suffering the consequences of bad prescribing. Many prescriptions are unnecessary, counter productive or inefficient (less expensive alternatives exist). Pharmaceutical companies spend tens of thousands of dollars on every physician in the country in order to influence their prescribing habits, not to improve health, but to improve their bottom lines.

Patients have a problem if a user fee forces them to question whether or not to fill a prescription. Either the drug that their physician prescribes is necessary or not. Why should a patient second guess their physician based on a user fee? If the drug that is prescribed is not necessary, the physician should be educated. If it is necessary, every effort should be made to ensure that there are no deterrents to filling it. Rather than shifting drug costs onto those who are sick, cost control for pharmaceuticals must start with proper prescribing habits for physicians, and that means countering the enormous pressure put on physicians by the pharmaceutical industry.

Only Campbell knows whether his proposal is intended to play political tricks, shift blame and further cut programs, but at its best it could be a very good idea for putting the responsibility for pharmaceuticals on the level of government that has the most power to deal with the pharmaceutical industry. The provinces, most recently British Columbia, have shown that they don't know the difference between cost control and cost shifting. When provinces can't control drug costs, it is not much of a solution to make sick people bear the burden. It would be a major step in the right direction to support Ottawa in an effort to expand Medicare while taking on the power of the far too powerful drug industry. Australia doesn't allow drugs to be introduced unless they can be proven to be more cost effective than what already exists. The United Nations' essential drug list is far shorter than the list of what the pharmaceutical companies market. There are alternative models for controlling drug costs while protecting health care. It is time that Canada stopped the federal-provincial fighting, and took a real step to expand and protect Medicare. That starts with a combined federal-provincial effort to control the pharmaceutical industry.